Senate Misses Deadline for Delaying Medicare Pay Cut

April 14, 2010 — Senate Democrats are still trying to postpone a 21.2% Medicare pay cut for physicians from April 1 to either May 1 or June 1, and they may get the job done by week’s end.

However, they have missed a deadline of sorts that may temporarily complicate physicians getting reimbursed by Medicare.

The pay cut technically took effect on April 1, but the Centers for Medicare and Medicaid Services (CMS) tried to spare physicians the consequences by instructing carriers to hold payment on claims for services rendered in April for the first 10 business days of the month — that is, through today. The hope was that Congress would postpone the pay cut before tomorrow, April 15, which would allow carriers to reimburse suspended physician claims at the old rate.

For the record, I want a fix to the SGR. And, as a practical matter this doesn’t change my practice as a hospital based doc. It will affect my bottom line, and we’ll see how that shakes out.

This doesn’t bode well for us as physicians. Since we’ve allowed ourselves to become dependent on / beholden to the feds for third party reimbursement, this perpetual game of chicken was bound to come to an end. And, it has, though not how anyone would plan, or foresee.

(For those who like fables, we’ve had the croc ride, and now we’re to be eaten).

There’s a significantly cautionary tale in this for the current healthcare legislation, which has been described to me, by a PhD Economist who’s read it (and had some hand in it) as being an Insurance Regulation bill, which aims to have docs be the ones who are responsible for healthcare rationing. It doesn’t work.

SGR was meant to have docs put some skin in the game of medicare expenditures, i.e., when costs exceed the SGR, docs get a pay cut. Had that cut happened at 1%, maybe it would have had a positive effect (choose your own positive), and perhaps not. Make it a 21% cut, and the effect is likely to be pronounced. And negative, in the common parlance.

So, brave new world and all that. I’d like to say I can make it up in volume, but we’re already crammed to the gills in ED’s all over, so I don’t know how this will work out.